Advances in both ultrasound technology and quantitative analysis of the placenta have permitted detailed assessment of key prenatal placental landmarks such as centrality of the cord insertion site, chorionic surface vascularization, the fetal-placental scaling exponent 3 (measure of placental vascular fractal structure); placental thickness and its variability, and placental roundness. Abnormal placental growth has been linked to adverse pregnancy outcomes including preeclampsia, intrauterine growth restriction, preterm labor, and stillbirth. There is increasing evidence linking abnormal placental and fetal development, referred to as fetal programming, to long-term health consequences in the offspring, extending even into adulthood. Indeed, birth weight has already been linked to later cardiovascular health and type 2 diabetes. It is believed that fetal programming is a result of inefficient fetal-placental nutrient exchange but the exact mechanism is not well understood. Often aspects of these important placental growth patterns can be identified by ultrasonographic examination at the end of the first trimester.
The ability to identify at risk placental growth patterns early in pregnancy, e.g., before the pregnancy is clinically compromised, would significantly impact both obstetric care and also initiate preventative measures even before birth. And despite growing evidence that deviations from normal placental morphology and growth trajectory early in pregnancy mark risk for adverse pregnancy outcomes for both the child and mother, an accessible and user-friendly, evidence-based algorithm to predict risk does not exist. Thus, there is a need for a recursive placental growth model to predict fetal, childhood and maternal health risks.